Functional Outcome in Paraplegic Patients from Spinal Cord Injury

Abstract

Background: Patients with Spinal Cord Injuries (SCI) are confronted with motor and sensory deficits as well as bladder, bowel and sexual dysfunction, which lead to a fundamental change of life. Because of the extensive medical, emotional and social consequences of the SCI, multidisciplinary management is essential. This study focuses on the functional outcome after a spinal cord injury.Methods: This was an observational study done during a period of 6 months from July 2007 to December 2007 among paraplegic spinal cord injured patients, admitted in the Neurosurgery Department and attended in the Department Physical Medicine and Rehabilitation, Chittagong Medical College, Chittagong. A total of 50 patients were selected for the study. Sampling technique was purposive and different scores and followup findings were collected and analyzed by Statistical Package for Social Science (SPSS-15) P value < 0.05 was considered as significant.Results: Mean age of study population was 32.7 years with all patients were between 18 to 55 years age range. Male and female ratio was 9:1. Maximum respondents were day labourer 36.0%, followed by 34.0% other different types of occupation, 10.0% business man, 8.0% service holder, 8.0% housewife and 4.0% student. Fall from height was the major cause of spinal cord injury of the present study group followed by Road Traffic Accident (RTA). Out of all patients 50.0% had urinary incontinence, 44.0% hadbowel incontinence, 46.0% had spasticity, 34.0% had hypotension and 4.0% had bed sore. At pretreatment stage mean (±SD) FIM score of the patients was 92.5 and discharge 107.32. (p <0.05). Spasticity of the patients was 2.6±1.55 at pretreatment stage and after six weeks of treatment mean (±SD) spasticity was reached at 1.96±1.07 (p <0.05). Visual analog scale was used to measure the severity of the pain. At pretreatment stage mean (±SD) pain score of the patients was 5.7±1.07 after six weeks of treatment mean (±SD) pain score was reached at 2.2±0.88 (p <0.05). At pretreatment stage mean (±SD) ASIA score of the patients was 3.0±0.81. After one week of treatment mean (±SD) ASIA score was reached at 3.12±0.72 and after six weeks at 3.38±0.69. ANOVA test was revealed statistical significant difference among groups in term of ASIA score of different treatment stages (F value=3.42, p value =0.035).Conclusion: For SCI rehabilitation program like physical therapy, occupational therapy, orthosis, gait retraining and management of complications make significant improvement in the term of FIM score, ASIA score, muscle weakness pain and spasticity which is proved by current study. So rehabilitation program is the only hope of spinal cord injury patients and physiatrist have important role to achieve the goals of functional outcome in paraplegic patient from spinal cord injury.Chatt Maa Shi Hosp Med Coll J; Vol.14 (2); Jul 2015; Page 52-56

Demography, Diagnosis and Complications of Spinal Cord Injury Patients in a Rehabilitation Center of Bangladesh

“…The Demographic variables author took into consideration were sex, age, employment status and income of the patient. Out of 201 study population 176 were male and 25 were female and this male predominance was also reported in the previous studies carried out both locally [14,[18][19][20] and globally [4][5][6][7][8][9][10][11]21] (Table 1). In this study most of the patients were in their 3 rd decade which consisted 28.6% , followed by 27.4% in between 21-30 years and 26.8% in between 41-50, which was also a common finding as reported by Hossain et al [22] where mean age was 47.44 ± 13.30 [17]; Ulrich et al found it 36.1 and according to Lali et al [21] mean age was 35.3, but in some studies the age of the study population was little bit different [4,14,16,18] (Table 1).…”

“…Out of 201 study population 176 were male and 25 were female and this male predominance was also reported in the previous studies carried out both locally [14,[18][19][20] and globally [4][5][6][7][8][9][10][11]21] (Table 1). In this study most of the patients were in their 3 rd decade which consisted 28.6% , followed by 27.4% in between 21-30 years and 26.8% in between 41-50, which was also a common finding as reported by Hossain et al [22] where mean age was 47.44 ± 13.30 [17]; Ulrich et al found it 36.1 and according to Lali et al [21] mean age was 35.3, but in some studies the age of the study population was little bit different [4,14,16,18] (Table 1). It was found that 93 of the respondent (47%) were employed and 103 were unemployed (57%) which somewhat correlate with Zahangir et al, who reported 36% of the patient to be day laborer [18] and also Ulrich et al, according to whom only 22% of the patients were full time employed but does not go in line with Lali et al and other articles [4,14,17,22] (Table 1).…”

“…It was found that 93 of the respondent (47%) were employed and 103 were unemployed (57%) which somewhat correlate with Zahangir et al, who reported 36% of the patient to be day laborer [18] and also Ulrich et al, according to whom only 22% of the patients were full time employed but does not go in line with Lali et al and other articles [4,14,17,22] (Table 1). A general trend of development of pressure sore among people with low income was found in this study which was also common in the other reports [4,11,18,19]. Most of the respondents of this study had paraplegia (56.5%) and the principle cause was trauma which was similar to the report Rahman et al but Guihan et al reported most of their patients (73.3%) had complete spinal cord injury [10, 14,20] but in all the reports the major cause of injury was reported to be trauma whether road traffic accident or fall from height or any other mechanism of traumatic injury [4,10,11,14,20,21] ( Figure 1).…”

Reproductive health related complications of spinal cord injury among patients at a specialized center in Bangladesh

“…8 Following SCI, most men experience impairments in sexual function and fertility, often due to erectile dysfunction, ejaculatory dysfunction, and abnormal semen quality. 9 The level of injury in men with SCI affects erectile function, with sacral and thoracic-lumbar segments playing a modulatory role. Studies have shown that reflexogenic erections can be retained in men with complete lesions above the sacral segments, and even in those with injury to the conus medullaris and cauda equina.…”

“…Complications include diabetes, urinary tract infections (UTIs), autonomic dysreflexia, pressure ulcers, worsening spasticity, and catheter-related issues. 9 The current approach to best practices regarding sexuality and reproductive health in individuals with SCI is opinion-based and typically relies on clinical experience with small patient populations in select hospitals and rehabilitation facilities. Recognizing the importance of this topic for improving the quality of life for individuals with SCI, the consortium for spinal cord medicine has identified sexuality and reproductive health as a high priority area.…”