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Rehabilitation Needs in Persons with Spinal Cord Injury in Post- earthquake Haiti Alexandra Rauch, M. Baumberger, E. v. Elm, F.G. Moise, J. Reinhardt
Rehabilitation Needs in Personswith Spinal Cord Injury in Post-
earthquake Haiti
Alexandra Rauch,
M. Baumberger, E. v. Elm, F.G. Moise, J. Reinhardt
The disaster
Disaster relief interventions
First response
Prevention
DeadInjuries
Lack of water and foodDecreased sanitary conditionsLack of Housing
• Search and rescue• Medical services and supplies• Clean water and sanitation• Emergency shelter• Food• Rubble removal and street cleaning• Logistics and telecommunications.• Family reunification and other protection concerns*
*United Nations: Haiti earthquake 2010 Flash appeal, Version 1.1. 16 January 2010
Disability Rehabilitation
Objective
The International Classification of Functioning, Disability and Health (ICF) provides a common framework for the description of functioning.
To explore the feasibility of a rehabilitation needs assessment using the ICF in persons with spinal cord injury (SCI) following the earthquake in Haiti
Methods
• Selecting ICF Core Sets
• Creating a documentation form
• Descriptive data analysis
1. Selection of ICF categories
Body functions and Body structures Activities and Participation
b134 Sleep functions d230 Carrying out daily routine
b152 Emotional functions d240 Handling stress and other psychological demands
b280 Sensation of pain d410 Changing basic body positions
b420 Blood pressure functions d420 Transferring oneself
b440 Respiration functions d445 Hand and arm use
b525 Defecation functions d450 Walking
b620 Urination functions d455 Moving around
b640 Sexual functions d465 Moving around using equipment
b710 Mobility of joint functions d470 Using transportation
b730 Muscle power functions d510 Washing oneself
b735 Muscle tone functions d520 Caring for body parts
b810 Protective functions of the skin d530 Toileting
s1200 Structure of the spinal cord d540 Dressing
s430 Structure of respiratory system d550 Eating
s610 Structure of urinary system d560 Drinking
s810 Structure of areas of skin d760 Family relationships
d850 Remunerative employment
Environmental factors
e110 Products or substances for personal consumption
e115 Products and technology for personal use in daily living
e120 Products and tecnology for personal indoor and outdoor mobility and transportation
e150 Desing, constructions and building products and technology of buildings for public use
e155 Design, construction and building products and technology for private use
e310 Immediate family
e340 Personal care providers and personal assistants
e355 Health professionals
e580 Health services, systems and policies
1. Selection of ICF categories
ACTIVITIES AND PARTICIPATION
„How much difficulty has the patient in…“
No
pro
ble
m
Som
e p
rob
lem
Co
mp
lete
pro
ble
m
No
t s
pe
cifi
ed
No
t ap
plic
ab
le
d230 Carrying out daily routine P 0 1 2 8 9
C 0 1 2 8 9
Description:
Rehabilitation need: Yes No
d240 Handling stress and other psychological demands P 0 1 2 8 9
C 0 1 2 8 9
Description:
Rehabilitation need: Yes No
d410 Changing basic body position P 0 1 2 8 9
C 0 1 2 8 9
Description:
Rehabilitation need: Yes No
d420 Transferring oneself P 0 1 2 8 9
C 0 1 2 8 9
Description:
Rehabilitation need: Yes No
d445 Hand and arm use P 0 1 2 8 9
C 0 1 2 8 9
Description:
Rehabilitation need: Yes No
d450 Walking P 0 1 2 8 9
C 0 1 2 8 9
Description:
Rehabilitation need: Yes No
d455 Moving around P 0 1 2 8 9
C 0 1 2 8 9
Description:
Rehabilitation need: Yes No
d465 Moving around using equipment P 0 1 2 8 9
C 0 1 2 8 9
Description:
Is able to organize and structure activities of daily living, sometimes calls for assistance
Is thinking a lot about his situation in the earthquake and the consequences. The recollection causes stress. Listening to music helps him.
Has some movement restrictions due to the spinal surgery which present little difficulty. Course of movement is not optimal
2. Rating of the extent of a problem
2. Rating of the extent of a problem
Extent of the problem
no mild moderate severe complete0 1 2 3 4
no some complete0 1 2
ACTIVITIES AND PARTICIPATION
„How much difficulty has the patient in…“
No
pro
ble
m
Som
e p
rob
lem
Co
mp
lete
pro
ble
m
No
t s
pe
cifi
ed
No
t ap
plic
ab
le
d230 Carrying out daily routine P 0 1 2 8 9
C 0 1 2 8 9
Description:
Rehabilitation need: Yes No
d240 Handling stress and other psychological demands P 0 1 2 8 9
C 0 1 2 8 9
Description:
Rehabilitation need: Yes No
d410 Changing basic body position P 0 1 2 8 9
C 0 1 2 8 9
Description:
Rehabilitation need: Yes No
d420 Transferring oneself P 0 1 2 8 9
C 0 1 2 8 9
Description:
Rehabilitation need: Yes No
d445 Hand and arm use P 0 1 2 8 9
C 0 1 2 8 9
Description:
Rehabilitation need: Yes No
d450 Walking P 0 1 2 8 9
C 0 1 2 8 9
Description:
Rehabilitation need: Yes No
d455 Moving around P 0 1 2 8 9
C 0 1 2 8 9
Description:
Rehabilitation need: Yes No
d465 Moving around using equipment P 0 1 2 8 9
C 0 1 2 8 9
Description:
Psychological support
Physical therapy
3. Determination of intervention need
Is able to organize and structure activities of daily living, sometimes calls for assistance
Is thinking a lot about his situation in the earthquake and the consequences. The recollection causes stress. Listening to music helps him.
Has some movement restrictions due to the spinal surgery which present little difficulty. Course of movement is not optimal
Sociodemograpic data (n=18)Sex Women
Men 11(61.1%) 7 (38.9%)
Age (mean) 36.7 (26;55)
Cause for spinal cord injury Earthquake Traffic
17 (94.4%) 1 (5.6%)
Level of lesion Cervical Thoracal Lumbal
1 (5.5%) 15 (83.3%)
2 (11.1%)
AIS (ASIA Impairment Scale) A B C D
13 (72.2%) 1 (5.6%)
3 (16.6%) 1 (5.6%)
Spinal surgery 9 (50%)
Number of pressure ulcers since SCI 0 1 2 3 4
5 (27.8%) 7 (38.9%) 3 (16.7%) 2 (11.1%) 1 (5.6%)
Marital status (post earthquake) Never married Married widowed With partner
2 (11.1%) 10 (55.6%)
5 (27.8%) 1 (5.6%)
Number of children (post earthquake) 0 1 2 3 4 5
5 (27.8%) 1 (5.6%)
3 (16.7%) 5 (27.8%) 2 (11.1%) 2 (11.1%)
Work situation (before earthquake) Employed Freelance Jobless Student Unknown
2 (11.1%) 7 (38.9%) 6 (33.3%)
1 (5.6%) 2 (11.1%)
Patient‘s perspective
Male, 43, AIS D, T12Trapped while working on a roof, Lost one of his five children (oldest sun),Housing completely destroyed. Acute care in Milot, since March 12th in HHA
“I don’t know how my family is living, my kids, my wife, It is such a big difference. I don’t know when I will be able to go to work and after I am here, I don’t know how I will live.”
Male, 43, AIS C, L1Trapped in the ground floor of his own house,
Lost his wife and eight children, Housing completely destroyed
Acute care in the Dom. Rep., since April 29th in HHA
“I try not to think about what happened to me. If I would, I don’t know what to do…”
Male, 27, AIS A, C6Trapped from collapsingbuildings while on the street.Acute care in the Dom. Rep.Spinal surgery in Milotsince March 12th in HHA.
„I am not the same person asbefore. It is such a big differencehow I live now in comparison tobefore. Thinking about it makes mevery sad. The only thing that I knowis that Jesus can help me to find myself and my way again.“
Female, 39, AIS B, T12Trapped while at the third floor
of a building. Housing completely destroyed.
Lost…Acute care at ‚Doctors without
borders‘, afterwards in Milot, since March 13th in HHA.
„My biggest problem at the momentare the finances. Before, I did not haveproblems because I used to have a business – buying and selling things...“
Patient‘s perspective
7
4
1
17
1
1
14
14
18
8
10
14
17
1
4
5
4
5
10
1
17
17
16
13
13
2
18
18
0% 20% 40% 60% 80% 100%
Sleep functions b134
Emotional functions b152
Sensaton of pain b280
Respiration functions b440
Defecation functions b525
Urination functions b620
Sexual functions b640
Mobility of joint functions b710
Muscle power functions b730
Muscle tone functions b735
Protective functions of the skin b810
Structure of the spinal cord s1200
Structure of respiratory system s430
Structure of urinary sytem s610
Structure of areas of skin s810
0 No Problem
1 Some problem
2 Complete problem
8 Not specified
Description of the problems
12
12
5
5
8
7
7
7
17
17
1
9
1
9
1
1
1
8
1
17
17
18
17
1
1
5
5
12
12
9
6
10
6
1
1
2
3
1
16
15
2
1
8
16
8
16
12
1
10
16
1
1
1
12
13
1
5
1
5
16
15
17
18
16
17
1
1
1
1
4
15
1
4
3
18
18
1
1
1
1
2
2
1
1
1
1
0% 20% 40% 60% 80% 100%
Carrying out daily routine d230P
Carrying out daily routine d230C
Handling stress and other psychological demands d240P
Handling stress and other psychological demands d240C
Changing basic body positions d410P
Changing basic body positions d410C
Transferring oneself d420P
Transferring oneself d420C
Hand and arm use d445P
Hand and arm use d445C
Walking d450P
Walking d450C
Moving around d455P
Moving around d455C
Moving around using equipment d465P
Moving around using equipment d465C
Using transportation d470P
Using transportation d470C
Washing oneself d510P
Washing oneself d510C
Caring for body parts d520P
Caring for body parts d520C
Toileting d530P
Toileting d530C
Dressing d540P
Dressing d540C
Eating d550P
Eating d550C
Drinking d560P
Drinking d560C
Family relationships d760P
Family relationships d760C
Remunerative employment d850P
Remunerative employment d850C
0 No Problem
1 Some problem
2 Complete problem
8 Not specified
Description of the problems
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Products or substances for personal consumption e110
Products and technology for personal use in daily living e115
Products and technology for personal indoor and outdoor mobility and transportation e120
Design, construction and building products and technology of buildings for public use e150
Design, construction and building products and technology of buildings for private use e155
Immediate family e310
Personal care providers and personal assistants e340
Health professionals e355
Health services, sytems and policies e580
Complete barrier
Some barrier
No barrier/facilitator
Some facilitator
Complete facilitator
Not applicable
Description of the problems
Areas of Rehabilitation needs0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Sleep functions b134
Emotional functions b152
Sensation of pain b280
Respiratory functions b440
Defecation functions b525
Urination functions b620
Sexual functions b640
Mobility of joint functions b710
Muscle power functions b730
Muscle tone functions b735
Protective functions of the skin b810
Structur of spinal cord s1200
Structure of respiratory system s430
Structure of urinary systems s610
Structure of areas of skin s810
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Carrying out daily routine d230
Handling stress and other psychological demands d240
Changing basic body positions d410
Transferring oneself d420
Hand and arm use d445
Walking d450
Moving around d455
Moving around using equipment d465
Using transportation d470
Washing oneself d510
Carrying for body parts d520
Toileting d530
Dressing d540
Eating d550
Drinking d560
Family relationships d760
Remunerative employment d850
Areas of Rehabilitation needs
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Products or substances for personal consumption e110
Products and technology for personal use in daily living e115
Products and technology for personal indoor and outdoor mobility and transportation e120
Design, construction and buiding prod. and techn. of buidlings for private use e155
Immediate family e310
Personal care providers and personal assistants e340
Health professionals e355
Areas of Rehabilitation needs
Required health professionals
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Physiatrist
Nurse
Physical therapist
Occupational therapist
Psychologist
Social worker
Orthopaedic technician
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Physiatrist
Nurse
Physical therapist
Occupational therapist
Psychologist
Social worker
Orthopaedic technician
Implications and impact on rehabilitation medicine
• Need for rehabilitation needs assessment
• ICF provides a useful framework for such an assessment
However
• Tools needs to be tested
• Further developments required
• Data usage should be clarified
• Data collection presents challenges
